NeuroDevelopment Center

SummaryBackgroundNeuropsychiatric disorders are among the leading causes of disability worldwide, generating substantial healthcare utilization and costs. Brazil, which hosts the world's largest universal public health system, implemented psychiatric reform to reduce dependence on long-term hospitalization and expand community-based services. The study aimed to assess hospitalization trends in Brazil between 2008 and 2022.MethodsWe conducted a nationwide, retrospective analysis of administrative data from Brazil's Hospital Information System (SIH/SUS) covering all psychiatric admissions (ICD-10, Chapter V) from 2008 to 2022. Outcomes included admission rates, length of stay, diagnostic distribution, demographic and regional disparities, and total hospitalization costs, adjusted for inflation. Data were standardized using WHO population projections and Markov chain Monte Carlo.FindingsPsychiatric hospitalizations declined by more than 50%, from 314,686 admissions (315 per 100,000 people) in 2008 to 151,113 (151 per 100,000) in 2022. The mean length of stay fell from 45.1 to 22.1 days. Schizophrenia spectrum disorders remained the leading cause of admission but decreased substantially (from 151 to 53 per 100,000 people), while mood disorders increased particularly among female adolescents (from 12 to 16 per 100,000 people). Males were hospitalized 70% more compared to females (males: 174; females: 102 per 100,000 people in 2021), mainly for substance- (males: 37; females: 10 per 100,000 people in 2021) and alcohol-related disorders (males: 32; females: 4 per 100,000 people in 2021). Marked regional variation persisted, with slower declines in the North. Total hospitalization costs fell by over 75% between 2010 (R$1,123,798,345) and 2022 (R$290,769,856), reflecting a sustained shift from hospital-based to community-based care.InterpretationBrazil's sustained reduction in psychiatric hospitalizations and costs demonstrates the long-term success of psychiatric reform and the expansion of community-based mental health care. However, regional and demographic inequities underscore the need for targeted investments to ensure equitable access and expand reform achievements amid policy fluctuations.FundingCNPq, INCT, CAPES, FAPEMIG.

Background Real-world evidence concerning the cardiovascular (CV) risk of umeclidinium (UMEC) monotherapy or UMEC/vilanterol (VI) is scarce. This real-world study investigated CV risk in new users of UMEC or UMEC/VI versus new users of tiotropium (TIO) in patients with chronic obstructive pulmonary disease (COPD). Methods This prospective, observational, multinational, cohort study enrolled patients ≥18 years with COPD who initiated UMEC, UMEC/VI or TIO between 2 February 2016 and 31 January 2023. Non-inferiority (95% confidence interval [CI] upper bound <2.0) of UMEC and UMEC/VI to TIO was compared for the time-to-first event (hazard ratio [HR] over 24 months) of a composite CV endpoint of myocardial infarction, stroke, heart failure or sudden cardiac death. Stabilised inverse probability of treatment weighting adjusted for differences in baseline covariate balance between groups. Incidence rates for the composite CV endpoint were calculated. Results In total, 6606 patients were enrolled; 6165 were included in the analysis. Both UMEC (n=1246) and UMEC/VI (n=2448) were non-inferior to TIO (n=2471) for the risk of the composite CV endpoint (adjusted HR [95% CI]: UMEC versus TIO: 1.254 [0.830–1.896]; UMEC/VI versus TIO: 1.352 [0.952–1.922]). Unadjusted composite CV incidence rates were low across cohorts (incidence rate [95% CI] per 100 person-years: UMEC: 1.157 [0.814–1.594]; UMEC/VI: 1.287 [1.034–1.584]; TIO: 0.924 [0.716–1.174]). Conclusions Both UMEC and UMEC/VI were non-inferior to TIO for composite CV risk, suggesting that physicians may consider escalating patients to dual bronchodilator therapy if COPD symptoms are not effectively managed with monotherapy.

This systematic review examined the association between communication skills and social anxiety in autistic youth ≤ 18 years old. A systematic search was conducted across six databases (PubMed/MEDLINE, Web of Science, Scopus, PsycINFO, Embase, and ProQuest) and gray literature to identify quantitative studies that investigated the relationship between communication skills and social anxiety in autistic youth. This systematic review was registered prospectively on PROSPERO (International Prospective Register of Systematic Reviews; Registration No. CRD42023415376). Six studies met the inclusion criteria, comprising a total of 682 autistic participants. Findings suggest a moderate relationship between social anxiety and communication skills, but this association varied depending on the measure used, the cognitive abilities of participants, and the specific communication domains examined. The association between communication skills and social anxiety in autistic youth is complicated and impacted by multiple factors, including measurement heterogeneity, cognitive abilities, and developmental stage. Future research should include larger sample sizes and adopt validated measures tailored for autistic individuals to enhance the consistency of findings and improve the understanding of the relationship between communication skills and social anxiety. Longitudinal studies are also needed to explore how relationships evolve across development. Understanding these associations has important implications for targeted interventions to support autistic individuals with co-occurring social anxiety. https://doi.org/10.23641/asha.30716924.

This study presents a pH-responsive hydrogel based on dynamic hydrazone bonds was developed using chitosan, gelatin, and pectin for oral sustained drug delivery. The hydrogel formed rapidly under mild conditions (<5 s for B3 and B5) and showed high water content (∼90%). It degraded slowly in PBS and trypsin but was selectively degradable in pectinase-containing media, adapting to intestinal environments. With BBH as a model drug, all hydrogels achieved >99% encapsulation efficiency (B3: 99.77%; B4: 99.13%). Drug release was well-controlled in gastric fluid (<50% in 2 h for B3) and sustained in colonic fluid (57.93% over 60 h), following Fickian diffusion (Peppas–Sahlin model, R2 > 0.98, k1 ≫ k2). The hydrogels also exhibited strong antioxidant activity (DPPH scavenging >60%, up to 75% for B2) and low hemolysis ratios, indicating excellent biocompatibility. Overall, the hydrogel demonstrates rapid gelation, high drug loading, pH-responsive sustained release, and biosafety, making it a strong candidate for colon-targeted oral delivery.

Attention deficit hyperactivity disorder (ADHD) in children is often misunderstood, mislabelled or missed altogether, especially when behaviours are dismissed as typical, defiant or trauma related. This article explores the challenges of recognising ADHD within a neurodiversity framework, highlighting how traits such as impulsivity, inattention, hyperactivity and emotional dysregulation can be masked, internalised or pathologised. It outlines how GPs can support families through early recognition, psychoeducation and collaboration with schools. The article underscores the importance of affirming language, holistic assessment and inclusive practice, and addresses the ongoing debate around ADHD diagnosis, emphasising the harms of underdiagnosis. This article is primarily intended to guide GPs by offering them insights and tools needed to better support children with ADHD and their families. We can help children with ADHD and their families access timely, compassionate care by equipping GPs to create neuro-affirming environments that foster trust with families. Early intervention and support can change life trajectories, ensuring children are not only recognised, but also understood and supported with the tools to thrive.

Abstract Smartphones, as more sophisticated versions of mobile phones, are expected to significantly influence how rural households manage their farms. This paper examines the extent to which smartphone ownership affects the adoption of modern agricultural inputs and technologies at the extensive margin. Using a rich, nationally representative household-level dataset from Nigeria and appropriate identification strategies, we find that smartphone ownership increases the likelihood of hiring labor, using phytosanitary inputs, and operating tractors. These findings suggest that promoting the diffusion of modern digital tools in rural areas can complement traditional agricultural input support programs, offering a promising avenue to enhance agricultural productivity and livelihoods in Nigeria.

Abstract Background Neuropsychiatric symptoms (NPS) constitute a major challenge for patients with Alzheimer's disease (AD). We explored NPS clusters in AD and longitudinally evaluated their association with function and structural neuroimaging markers. Method Participants with AD ( N = 111) were included from the Ontario Neurodegenerative Disease Research Initiative. NPS were assessed using the Neuropsychiatric Inventory Questionnaire (NPI‐Q). NPS clusters were identified through exploratory factor analysis at baseline. We evaluated 34 bilateral cortical regions of interest (ROIs) and 9 bilateral subcortical ROIs using volumetric information from MRI data evaluated annually over 3 years. We examined longitudinal associations between NPS clusters with basic (ADLs) and instrumental (iADLs) activities of daily living, as well as with subcortical and cortical volumes, using mixed linear regression models controlling for age, sex, MoCA, education level, and visit number. Result Factor analysis identified four symptom clusters explaining 62% of the variance. These were labeled “behavioral” (disinhibition, irritability, motor disturbance, and agitation), “psychotic” (hallucinations, delusions, and euphoria), “neurovegetative” (apathy and appetite), and “affective” (depression, anxiety, nighttime behavior) clusters. The “behavior” cluster was longitudinally associated with left middle temporal (β = ‐382.6, p = .006), right lingual (β = ‐456.0, p = .01), right nucleus accumbens (β = ‐5656.6, p = .004), and right thalamic (β = ‐700.7, p = .008) volumes. The “neurovegetative” cluster was longitudinally associated with left fusiform (β = ‐195.4, p = .03), left middle temporal (β = ‐282.3, p = .001), and right nucleus accumbens (β = ‐3176.7, p = .01). The “affective” cluster was associated with left rostral anterior cingulate (β = ‐1423.4, p = .0003), right entorhinal (β = ‐804.3, p = .03), right medial orbitofrontal (β = ‐830.6, p = .001), right pars opercularis (β = ‐911.6, p = .001), and left putamen (β = ‐729.5, p = .004) volumes. Longitudinally, all clusters predicted iADL outcomes and clusters 1, 3, and 4 predicted ADL outcomes. Greater NPS burden, male sex, visit number, older age, and lower MoCA predicted worse function. Conclusion NPS clusters in AD separate into behavioral, psychotic, neurovegetative, and affective dimensions. These clusters demonstrate unique associations with function and neuroimaging markers.

Limited information exists regarding the impact of neurofibromatosis type 1 (NF1) on patients' sexuality, despite its significance for Quality of Life. We therefore explored how adult patients with NF1 experienced their sexuality. A cross-sectional study was conducted among adult patients with NF1. Sex life was ranked on a self-report scale ranging from 0 (very unhappy) up to 10 (very happy). Male sexual function was measured by the International Index of Erectile Function. Female sexual function was measured by the Female Sexual Function Index (FSFI). Differences between variables were analyzed using parametric tests. Out of 568 patients, 294 respondents (52%) started the questionnaire, with 202/294 (69%) completing it. The mean age of respondents was 37 years (range 18-75 years), and 63% were female. Self-reported sex life was rated 4.9 (SD 3.1) for the total group. About 48% scored their sex life ≤ 5. Men with erectile problems (67%) scored their sex life significantly lower than men without erectile problems (4.0 vs 7.2, P < .001). Women with sexual problems (64%) on the FSFI scored their sex life significantly lower than women without sexual problems (3.8 vs 7.5, P < .001). Half the respondents scored their sex life as inadequate, with about two-thirds experiencing sexual problems. This research seems important to better address sexual health in a clinical setting.